Allopurinol Dose Escalation for Gout Does Not Improve Mortality

Linked to small increase in mortality; at 2 years, 31 percent of dose escalators achieved serum urate goal.

HealthDay News — Allopurinol dose escalation is not associated with reductions in mortality risk among patients with gout, according to a study published in the August issue of Arthritis & Rheumatology.

Brian W. Coburn, PhD, from the University of Nebraska Medical Center in Omaha, and colleagues assessed whether allopurinol dose escalation is associated with cause-specific mortality in patients with gout. The authors performed a 10-year observational, active-comparator study of US veterans with gout who initiated treatment with allopurinol. The study included 6428 dose escalators and 6428 matched non-escalators.

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The researchers found that there were 2867 deaths during the observation period. There was an increase in all-cause mortality among dose escalators (hazard ratio, 1.08; 95% confidence interval, 1.01 to 1.17). Similar effect sizes were seen for incidence of cardiovascular-related deaths (hazard ratio, 1.08; 95% confidence interval, 0.97 to 1.21) and cancer-related deaths (hazard ratio, 1.06; 95% confidence interval, 0.88 to 1.27). At 2 years, 10% of dose escalators were receiving a final daily dose of >300mg and 31% had achieved a serum urate goal of <6mg/dL.

“A strategy of allopurinol dose escalation, which in current real-life practice is characterized by limited dose increases, is unlikely to improve the survival of patients with gout,” the authors write.